Factores de riesgo de mal pronóstico tras cirugía reconstructiva de la mama tras mastectomíaimpacto en la calidad de vida percibida
- Ramos Soler, Francisco José
- Jose Aguilar Jimenez Director
- José Luis Aguayo Albasini Director
- Benito Flores Pastor Director
Defence university: Universidad de Murcia
Fecha de defensa: 25 October 2024
- Pablo Ramírez Romero Chair
- Diego Flores Funes Secretary
- Diego Mansilla Molina Committee member
Type: Thesis
Abstract
Introduction: Breast cancer is the most common cancer among women, and the appropriate diagnostic and treatment processes not only affect survival chances but also quality of life. For patients who opt for it, breast reconstruction following mastectomy due to breast cancer has become a fundamental component of comprehensive treatment. Its complications can not only impact women's quality of life but also delay the initiation or continuation of adjuvant therapies. Implant loss is the ultimate outcome of other complications, making it crucial to understand the frequency and contributing factors to this issue. Materials and Methods: A retrospective observational study was conducted from January 2010 to December 2021, along with a cross-sectional study on quality of life between July 2022 and January 2023. The study included breast cancer patients who underwent prosthetic reconstruction and were followed up at our center. The following were performed: (1) Development of a predictive tool for implant loss. A multivariate analysis and binary logistic regression were conducted, internal validity was calculated, and both a LOESS calibration curve and a ROC curve (with specificity and sensitivity) were designed. (2) Measurement of complications following prosthetic reconstruction in our setting. (3) Identification of risk factors for poor prognosis in our setting. (4) Evaluation of the safety of acellular collagen matrices in prosthetic reconstruction surgery. (5) Assessment of the feasibility of using the BREAST-Q online tool as a measure of quality of life. A comparative analysis was performed based on individual responses as well as the quality of life domains analyzed in the BREAST-Q questionnaire. Results: A total of 216 mastectomy and prosthetic reconstruction procedures were analyzed, 144 (66%) performed unilaterally and 72 (34%) bilaterally. In 36 cases (16.6%), removal of the primary prosthetic implant was necessary. Significant differences were found in the following variables: age under 50 years (Odds Ratio [OR] = 0.55; 95% Confidence Interval CI]: 0.3-0.99), smoking (OR = 5; 95% CI: 2.3-10.97), postoperative radiotherapy (OR = 7.44; 95% CI: 3.4-16.4), and chemotherapy (OR = 2.5; 95% CI: 1.1-5.9), with these being independent predictors of primary implant loss. Based on the logistic regression model, a predictive tool for primary implant loss was developed, demonstrating good calibration (Hosmer-Lemeshow test: p = 0.247) and achieving the highest Youden index (0.7) at an 18.5% risk of primary implant loss (sensitivity = 78%; specificity = 85%). The most frequent complication leading to implant removal was the necrosis-infection sequence, observed in 16 cases (44%), followed by isolated necrosis in 15 cases (42%). Rescue with either a new prosthetic reconstruction or a new autologous reconstruction was performed in 18 patients (50%) who experienced primary implant loss, with reconstruction failure occurring in 18 (8%) of the total cases. No association was found between the use of acellular collagen matrices and the development of complications. There were no significant differences in quality of life between patients who experienced primary implant loss and those who did not. Conclusions: It is possible to develop a predictive tool for implant loss, with the main factors being age, smoking, postoperative radiotherapy, and postoperative chemotherapy. The most frequent complication was the necrosis-infection association. Acellular collagen matrices are not associated with a higher number of complications. Quality of life is not affected by primary implant loss.